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VIDEO - DUwHF #825 Millennial Dentist
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About The Millennial Dentist Podcast:
Ultimately, this all began as a couple buddies sitting around talking about dentistry and trying to figure out how to make it. Well, we have a long way to go before we make it, but we do know that the collaborative approach of learning from each other will help us get there!
We will be the first ones to admit we don’t know everything and probably don’t know the half of it!
The three of us have been very fortunate to have great mentors and this podcast is really just a way for us to pay it forward. We will try to interview smarter people, give a millennial perspective to different issues in dentistry, and provide a little entertainment along the way!
At the end of the day our goal is that all dentists, both new and seasoned, young and old, male or female, from all over the world will be encouraged by what we have to say!
We would love to hear your feedback and thoughts so please don’t hesitate to reach out to us. So sit back, crack a cold one, and enjoy!
Dr. Sully: Welcome back everybody to the Millennial Dentist podcast. Peyman and I are here at his office Friday morning, beautiful day in July and we are super pumped to have a super special guest, one that both Peyman and I have looked up to for a while after spending tons of time on Dentaltown and school, but Howard Farran himself.
Dr. Peyray: Yes.
Dr. Sully: Welcome, Doc.
Howard: Oh, man. It’s such a huge honor to be on your show. It’s so damn cool watching you guys.
Dr. Sully: We appreciate it though.
Dr. Peyray: We appreciate it. Honestly, this is extreme. Last month, me and Ryan talking like, "Man, can we get him?" And I've been very blessed and excited to do this, man. Been waiting for this.
Dr. Sully: What’s new with you?
Howard: What's new with me? Gosh, I just celebrated my thirty year anniversary in my dental office, and you just opened yours up, so you're like my kids. Just having grandbabies, that's the new thing with me. Just got another one. When you're fifty-four, the neatest thing in the world is grandchildren. You guys have kids?
Dr. Sully: No kids.
Dr. Peyray: No kids.
Howard: No kids. You guys are dental millennial geniuses.
Dr. Peyray: We're trying to be.
Dr. Sully: We're trying to change the perspective a little bit. I feel like millennials are getting a bad rap a little bit, so we're trying to show the positives of what our generation is bringing to the table.
Howard: Well, when you get to my age, you don't figure out what's right and wrong. You just start recognizing patterns. Every generation going back to recorded literature thinks the next generation is gonna screw up, but then you look at every hundred years it goes by, the civilization just gets better and better and better. So, this is a pattern. It's kind of like if you go into religion like 20% think the end of the world is coming. So, you leave that. You say, "Well, is it or is it not?" Well, you go on Wall Street. 20% think the stock market's in a crash any day. I mean you go into dentistry, 20% think– when I got out of school thirty years ago, it was capitation, it was gonna ruin dentistry. Then it was OSHA and then it was HIPAA, now its corporate dentistry, and then you realized after thirty years, "Hey, look. Nobody can keep all their patients in dentistry so why is anybody else gonna do it?" You go to any dental office with five thousand charts; four thousand have never come back, so you really think Aspen Dental and Heartland is your problem?
Dr. Peyray: You're exactly right.
Dr. Sully: And most people are tracking that so they have no idea what's actually happening when they look at it. Hey, couple things. So, I guess the first thing I really wanted to get your opinion on, talk to you about and then there's a couple of things I want to hit on, but you know part of one is like you said. You're celebrating your thirtieth anniversary, Peyray's six months in and we're both basically two years out of school, three years out of school. If you had to give your nuggets of wisdom to the graduating dentist, the new dentists, I mean you've seen it all. You've been through those generation changes -- the changes in the industry. What are you telling new graduates? What is your advice? That's the big thing I wanna hear is kind of just talk about a lot of that stuff.
Howard: All right. Feel free to interrupt me. I don’t wanna rant –
Dr. Sully: We will don't worry.
Howard: I don't want you guys to have to like get up and get a beer just to wait until I finish ranting.
Dr. Sully: That's an old man, Farran. We’ll talk about that later.
Howard: It's the same pattern like, let's switch from dentistry to a real estate agent. You get this car, and they got all this alphabet soup behind their name. You don't know what any of that crap means. Then you go talk to your 401k guy and he's got all this alphabet soup behind your name. Nobody knows what any of that alphabet soup. They don't even know the difference in DMD and a DDS or a MAGD, and all that diplomatic crap. What you need the most is the chairside manner. What you need the most is to be able to connect with humans. Now the research is showing that you only got like fifteen, twenty, thirty seconds to make this happen and the dentists that crush it– they have that skill with their staff; they're able to attract and retain qualified key staff. Like talk about practice management. I mean, there are a dozen amazing practice management consultants, but you don't even have to learn any of that if you hired an office manager who already knows all that. If you can attract and retain, I mean some dentists get to work, and they're control freaks. They don't understand leadership. They'll walk in their office, or they'll walk up to the front desk. The first thing he'll say is, "Why do I have an opening from 2:00 to 3:00?" And she sits there looking at you like you're a monster, like a good morning to you. You're an idiot.
Dr. Peyray: So true.
Howard: Having the soft stuff is the only thing that matters. You sell the invisible. When I go buy an iPhone I mean, shit, you could buy it from an ATM. I mean, it's an iPhone, it's a standardized product. When you go buy a Coca-Cola, you actually do get it out of a machine. Bottled water, it is just bottled water, but when I come up to you, and you say, "Well, I know you came in here for a twenty dollar oil change, but I really need to change your transmission fluid and your air filter pump." Well, in about five seconds I'm gonna look at you and think, "Are you selling me for money or do I believe you?" Your air conditioner goes out so some man shows up and he says, "You know what? Your air conditioner is old. You need a $9,000 new air conditioner". And in about five seconds I'm just looking and thinking, "Do you just want $9,000? Do I really?" You're selling the invisible. When you tell them that they have four cavities and that they're $250 each, they're thinking, "Okay, do you just want a grand? I mean, a thousand bucks? I mean, you're trying to go to Disneyland?" So, to get that, it's all the soft stuff. So, the dentist who understands people and makes the conscious effort– Now some people, some dentists are just born monsters. They're dex, they're not nice guys, but they turn Hollywood when they go to the dental office. I mean, look at these actors. They'll tell some actor, "Okay, now we're gonna do a movie, and you're gonna be Gandhi." Well, they're just like, "Okay, I'll become Gandhi." And then the whole movie they're Gandhi. When you walk in that door, you go from your car to on stage with your staff and your patients. And the people that just know how to press the flesh run for mayor, have a right look, make people likable in five or ten seconds. So, you're gonna do a hygiene check. Some people go down, and they sit down. The first thing they just do is start looking at the x-rays. It's like, "Well, good morning to you. Am I just a set of teeth in a chair or am I a human?" Then there's that other dentist who walks in there and just makes eye contact and grabs her hand. I'm in Phoenix, where there's a gazillion eighty-year-old ladies that retire down here that aren't gonna live in the snow in north and south. 10% of this town is from Canada. My God, what is the only thing a seventy, eighty, ninety, hundred-year-old woman wants when she goes to her dental office? A big old bear hug from Dr. Farran.
Dr. Sully: That’s some woman, yeah.
Howard: I only kiss them on the forehead if they're like in their sixties, but my seventy, eighty, ninety, a hundred, it's on the mouth. They forget it they love it. I give them a big old hug; I tell them they look great. I ask them what's going on and you establish that likability and trust. I've had my dental assistant for thirty years. There's about a thousand, probably several hundred old men that only come to my office because Jan always gives them a big hug. That's the skill set that makes you successful. And if you got that down and you do really shitty dentistry, you'll still have a million dollar practice. If you went to all the alphabet soup stuff, you went to every Institute, Pankey, Spear, Dawson, Coyes, whatever and have all this diplomat crap behind your names and you don't connect with your staff and your patients, you're always behind the eight-ball. So, that's my first point.
Dr. Sully: So, let me stop you there because we’ll reconnect because that was so huge. So, the first point being relationship with team, being able to connect with them and not be a dick basically. Then the other is how do you–
Dr. Peyray: Communicate with patients.
Dr. Sully: What's funny is that I feel like most graduates, we graduate, and we're like, "Oh, we got to figure out how to do this, do that." And I'd be willing to bet that– knowing the type of people that end up in dental school and our colleagues that probably less than 70% of them, at least half of them suck at that. No one's getting CE in that. No one's trying to learn how to be a better communicator or how do I work with patients. Frankly, the words sell dentistry, right? Like if we don't create value for what we do then ultimately it falls on dead ears, and we are just the car salesman trying to get them to change their transmission fluid or whatever that is. So, I love those two points because that I think probably some of the biggest reason we've been successful is not our ability to -- yeah. We've had really good mentors, and we've learned a lot of good skills, but we could both talk to a brick wall, and we're pretty good at creating that value. The majority of people graduating aren't and then we don't want to go learn how to do it.
Howard: Well, like when I get my oil changed do I really care if the kid is twenty-five years old and six months out of auto mechanic school?
Dr. Peyray: No.
Howard: Or fifty-five or sixty-five. I assume you work here. I assume you know how to change oil or I assume you know how to fix my filling. You think into it because you know all the little details that Carl Misch can place an implant better than your dad and your dad can place one better than you, but the consumer doesn't ever think things like that. The deans are accepting everybody with the wrong skill sets. Like how do you get in the dental school? We got to get A's in Calculus, Physics, Geometry, and Chem. Well, who are those people? The idiot nerds sitting in the library every night who never joined the frat or never had a date or -- I mean, every single night at Creighton I heard the same thing. "Ding, the library will be closing in ten minutes." Then I'd walk back from the library to Swanson hall dorm, and all the business majors are drinking beer, they're sneaking in girls into it an all-boys Jesuit dorm, talk and I thought they were like vile and disgusting. We're here to learn, and you're making abuse of it.
Dr. Peyray: Oh yeah.
Howard: And then they do –
Dr. Peyray: I'm glad you mentioned this, go ahead I'll tell after this. In dental school, I feel the one thing that I always complained was like, why didn't we have business classes? Why didn't they really teach us management of how you manage your money in business? Then when I got out or going to a school and then getting out, I realized really business is not what we needed back in school as much as we needed communication with the patient. Like what you just mentioned today is so much more valuable to me and a lot of the kids in school now. I think that genetics plays a big role too, Howard, as far as how you become likable, how you make that persona and that the patients like you because of you're not only their doctor, but they can call you their friends when they're out of town or anything like that. So, that whole communication thing, I feel like that could be more emphasis in schools also. What's your input on that versus the business in school?
Howard: Did your schools teach you your religious beliefs? Did your school teach you your cultural, your music beliefs, your dietary habits? Dentistry is a craft. It's a hands, work with your hands, welding. It's all surgery. You wanted to be a surgeon they taught you how to be a surgeon then you walk out of school and say, "Well, hey you didn't teach me whether I should have voted for Trump or Hillary or be atheist, agnostic, or Jewish." The schools just do their craft and there's no one in the school that ever ran a business. I mean those who do, do and those who can't teach. So, I don't think there's anybody even in the school that could teach it. And the schools, not only are they accepting the wrong skill sets of a person since we sell the invisible and it's a trust-based society. When I check into a hotel, why did the maid put that wrap on the toilet seat? Because she's selling invisible. I didn't see her clean; she's trying to tell me, I don't know her, she doesn't know me. She said I clean the toilet. When you order a drink or you order room service. I'm a health food fanatic, I believe that you have to have cranberry juice, just heals all your organs. So, every night before I go to bed, I always want a double Grey Goose with a splash of cranberry juice in there just for health purposes.
Dr. Peyray: Seems perfect.
Howard: And they still leave a piece of the straw on because the bartender's saying, “We're a class act. I mean, we're selling the invisible”. Dentistry is all invisible. Nobody knows if they have a cavity or not. Nobody knows if what you say is true. Then the other thing that dental schools do wrong is they do the wrong demographics. They thought that if they swelled the classes from four thousand to six thousand, it would push you guys all out into the rural. That's why everybody thought the best idea for availability, accessibility when you look at the Midwest, where 11% of these towns don't have one single dentist, but now what they know for a fact is, who's the only person who will live in a town of five thousand? A boy born in a town of five thousand. So, if you want dentists to go rural then stop accepting them from Memphis and Nashville in Chattanooga and start accepting them only from towns under five thousand and they'll go back there.
Dr. Peyray: Oh, it’s perfect.
Howard: Yeah. So, the skill sets are not met.
Dr. Sully: One of the big things I learned very quickly on and we see it all the time, and I'm sure you see it is; when we graduate, we go to dental school, we're taught to make these just giant treatment plans from start to finish and diagnose everything we see, every little thing, and then we like print that out, we give that to the patient and we say, "Here's your treatment. We're gonna start here and go". It's like this big, you know in dental school that may not be that big of a number just because dental school's prices are cheaper. Now you do that and with a new patient that comes in who's been to a bunch of other dentists and has had some dental work and doesn't have done it and you give them a $15,000 treatment plan then they're freaking gone. Like, they'll run out the door, they're going to get to the next dentist to get a second opinion who's gonna do something less than you did, obviously, and then they're never coming back to you. So, you know that was a big thing for me was trying to learn how to treatment plan a little differently. Not to not tell patients what they need, but just not to overwhelm patients out of the gate with the kind of the mindset we were taught in dental school.
Howard: Well, what are you driving right now? What car are you driving? How old is it? What did it cost you?
Dr. Sully: A ’96 Toyota Tundra. It was like 12 grand.
Howard: So, you're driving a $12,000 car that's basically eleven years old.
Dr. Sully: Yes.
Howard: All right. And Peyray, what are you driving?
Dr. Peyray: Nissan Altima 2010 with 80,000 miles on it. I bought it brand new for dental school and I've been driving it since I graduated.
Howard: What did it cost? What did you pay for?
Dr. Peyray: Cost? I mean it's been paid off by $24,000 when I bought it.
Howard: Okay, so here's the point. So, the average price of a new car in America right now is about thirty thousand bucks, okay. It's actually like thirty-three thousand, let's just say thirty thousand bucks. I'm gonna ask you guys, what percent of Americans in their lifetime will buy an average new car?
Dr. Sully: A lot.
Howard: What percent?
Dr. Sully: 50%. 75%.
Howard: Okay, so you say 50% to 75%. What percent of dentists have never, ever sold a single treatment plan for that price of a new car? Thirty thousand.
Dr. Sully: 90%.
Howard: Yeah. So, the consumer has shown you. Yeah, we dropped $30,000. Hell, what is an F-150 decked-out truck cost these days out in the rural areas?
Dr. Sully: Fifty-sixty thousand, some of those.
Howard: Absolutely. These people have no problem doing fifty, sixty. So, it's the treatment plan presentation where some people – okay, I'll give you an example. I've got money. I got a 2005 Lexus with like a hundred and fifty thousand miles while I only lived 3.0 miles from my dental office and 3.5 miles from Dentaltown. So, every time I take it in for an oil change, they say, "Well, if you give us your car and give me a check for $95,000 we give you a new one". Now they didn't say you have to buy a new car and I never came back, they just showed me what's going on and I'm like, "Well, you know I just don't want to give you ninety-five thousand upgrade. A Lexus said it's never farted since 2005 and I only drive it three miles. I actually think it's gonna be cool ‘cuz I really want to get a quarter million miles out of it. I mean I'm a cheap bastard and I'm at 140, and I want to get a quarter million miles of that. The bottom line so you can present that you know well, I'll tell you what I mean. Obviously, you don't have to do anything. I don't think anyone's ever died from a dental cavity. Obviously, we could just do everything and you could leave here with a brand new car, and it's gonna cost you 25 grand. Now they don't want to hear, "Well, number three we'll need an RCT build up in a crown and number four - they just want to know a price. When you go to a car lot, they say, "How much is a car?" "Well, did you want a transmission because the transmission is gonna be twelve hundred. Did you want wheels on it?" Just shut up and tell me the price. Omar Reid, I watched that guy in Phoenix do it better than anyone. I mean, Omar Reid to walk up there and he just looks in their mouth, he doesn't look at the direction, he just looked at their mouths. He says, "Look, we could do nothing. I'm pretty sure at your funeral they're not gonna say you died from a dental cavity. What’s your concern about, why you came in you broke that tooth, we can crown that for thousand bucks we start it today". If you said to me, I want to leave with a perfect set of teeth, that's 25 grand. I don't care what you do, but I need to know what you want to do. Well, if you said it to five people and one said yes, we did a $25,000 treatment plan. If you said it to a hundred people, one said yes, you got 25,000 treatment plan. I'm telling you 90% of dentists have never done it one time in their entire life, and half their patients did in the last five years. I mean this country sells million. I mean, sometimes they'll sell twenty-five million new cars a year in this country of 325 million. Clearchoice, but last year they sold 18,000 arches of All on 4 for 25 grand an arch. If you're getting upper and lower done, you give him 50 grand. So, they can do that 18,000 times a year and the dentist practicing across the street has never done it at one time in forty years.
Dr. Sully: So, let me interrupt you with that a little bit though. That's a great point; I totally get that. My question then becomes, how do we do that? How do you start to do that and then and the other thing is I feel like maybe this is the excuse because I've only been a dentist for so long, but then it boils down the money, and then they don't have. With the car thing, they don't sell $50,000 cars, they sell $300 payments, right? That's the whole mindset there. Do you believe that we should be doing more payment plans stuff to make things affordable or how do we get to the point that we're confident enough to where we can present a $25,000 treatment plan and not shaking our boots?
Howard: Well, okay, so in the United States, anything over $1,000 is financed 90% of the time. So, only 10% buy purchases over a thousand; a car, a house in cash, they're always over sixty-five. So those are the idiots you decide to give a discount to. "Well, we're gonna give you a senior citizen discount since you don't have any kids. You paid off your house, you don't have a car payment". You should give the Mormon lady with five kids that the senior citizen discount because she's broke. But yeah. Financing is everything. I'm Irish, and we were saved by Mr. Singer. There were like 85 different sewing machine companies, but 1 million Irish washed up on the shore after the famine 40 years before the Statue of Liberty. The only jobs were textiles, but in the textiles you have to have a sewing machine. They were 50 bucks. There was one guy from Ireland that had 50 bucks, and everybody wanted to have their 50 bucks. So, old man Singer said, "I'll tell you what. I'll give you the sewing machine, and you'll get a $3 a week job. On Friday, when you get that three bucks, you have to come back and give old man Singer a buck. He bankrupted everyone. Everybody says that Henry Ford started the assembly line. It's like okay, but what's the end of the story? Why did they close it down? Because GM started GMAC financing. He said old man Ford; he wants 668 bucks cash. You come over to GM and get a Chevy and we're gonna make installment credit. So, everybody who comes to an industry with installment credit walks out as the leader. So, you have to have financing and the reason I love Care Credit most this is no advertising, no money, nothing like that is because the care credit they don't want any new patients. Every dentist in America has already signed up for them and used them once. The best thing about Care Credit is to blow yourself limiting beliefs because they will come into your office with your staff and then you can say, "What do you want to look at?" "All the dentists in this area". "You want to look by a zip code, you want to look by – what do you want to look at?" They'll open up and say, "Okay, you. Your average Care Credit is $400 and for your whole zip code it's only $418." Look at these two guys and here's their damn name, here's their address. These guys their average is 5,000. So, you're telling me that everything's wrong because Korean North, Putin, and Trump met with a Russian you know all this bullshit toxic noise because you would rather backseat drive the White House than backseat drive the man in the mirror. They'll say, "Well, dude how come you're all young, good-looking, hot, energetic, and you only did three Care Credits last month for 400, and that old, fat, bald guy across the street did five that were over 5,000 last week. So, when you see that, it really checks your balance. That's why I love Care Credit.
Dr. Sully: No, that's huge. That's kind of eye-opening. I wanna look at ours now too, because I feel like that's an area where we totally –
Howard: Bring the rap in.
Dr. Peyray: It's funny you said Care Credit. They were number one in the country when I was at the corporate because our office manager, Melinda, she did a great job of doing the Care Credit. We sold $900,000 that year in the Care Credit. They came from –
Howard: You don't walk into the room and say, "Well, my god we did everything you needed. It'd be five grand". They walk in there and they smile, "How are you doing? Great". Well, I'm so excited because you have amazing credit. If we did everything the doctor thinks you need, it would only cost you $80 a month for three years to get everything fixed up. The only thing they heard was, "I like you. You're likable. You're sweet. I'm smiling. Who doesn't have $80 a month for three years? Boom.
Dr. Sully: Yeah.
Howard: And on the treatment plan presentation I always like to talk about Seinfeld too. I love stand-up comedy the most. I've done it a hundred times because you know there's no props, there's no monitors. I don't even like comedians that pull out a puppet or a toy box or – I respect Broadway a hundred times more than a movie because some of those movie scenes they’ll take thirty, forty cuts where Broadway's live. And Seinfeld, we'll talk about how on Monday he'll write a joke. Then Tuesday his whole day, he wants to take one word out of that joke– make it tighter. Wednesday he'll do the same. So, he'll write a joke on Monday and Tuesday, Thursday, Friday, Saturday, the rest of the week is I don't want to say a joke in 19 words if I can say it in seven. The quiet, the succinct, that's how humans work. So, what's the dentist response? He's staring at x-ray babbling about a root canal for five minutes. I mean imagine –
Dr. Sully: We talk ourselves out of stuff, yeah.
Howard: Oh my god. If I went to a doctor and said, "Hey, you need a... you know you're fifty." When I turned fifty said, "Look, you're fifty so you need a colonoscopy, you need an MRI of your brain, and you need a – I think that was he said. I said, okay. That was it. He didn't explain to me for an hour and a half of what could possibly – Then when I do colonoscopy, I walked in there he didn't like show me previous video films he'd shot in other people's assholes and all the things he had found from lumps and bumps to a set of car keys. He's just like, "You're fifty, dude and colon cancers, you know we would just need to do that."
Dr. Sully: It's the real deal, yeah.
Howard: These dentists they just talk and talk and talk and then their treatment plan acceptance rates and I'll tell you one thing macroeconomically on treatment plan rates. What we see generally within any ZIP code in America is that one in three people always get their cavity filled. One in three people never gets their cavity filled. You can get that one in the middle. So, the national average closure rate on just a cavity is 38% and you'll go into a zip code and 80% of the dentists are just doing this one out of three. Then there's a practice in the same building, the same everything, doing two out of three. The difference is one of them is likable and is really focused on treatment plan presentation, whether docs do them himself or got a treatment plan presenter. On your chart, you should be asking these Care Credit question. I mean you're asking them if they've ever had syphilis, gonorrhea, or chlamydia. I mean these are questions you ask in a bar on Second Avenue. What the hell is that gonna affect on my treatment plan? That way when they go in there, they're not saying, "Well, it's 5,000 stress drafts and we got to see if we can get your credit approved." They think, oh my credit is horrible, and it's all these drafts. Well, no we'll just wait or just blah blah. Ask him on the deal, fill out this form and then the treatment plan president goes in there and says, "Oh, my God. Congratulations. You guys got amazing credit". Oh, my God. Sully, we can do everything for $89 a month for 60 months.
Dr. Sully: So, go back because I like this. So, you're saying that – ‘cuz that's kind of how it's been in our office, why we probably suck at it. It used to be like, It's gonna about $10,000 of work you could pay it this way, or we can do Care Credit Lending Club, and they'll see if you're approved, blah blah blah. So, then they go up there, and then a lot of times they got a – They have to do it either at home or in the office sometimes, but we're not doing that very well clearly. Are you saying you try to get this some of the stuff like pre-approved for the front end or like what sure the work level?
Howard: Well, I don't really care what you do as long as it works. I'll go to hamburgers because you know I grew up – I cut my teeth at Sonic Drive-in. My dad owned the Sonic Drive-in, and that's the only place I ever saw my dad and I spent a dec in there, that's where I learned all my business and loved it. Look at hamburgers. I mean there's Wendy's, there's Carl's Junior, there's In-and-Out, there's Mcdonald's. There's a hundred ways to make a hamburger. They owned up some – what does that new one there? Five guys or something? I've never even been there.
Dr. Sully: That was good.
Howard: But now there's some five guys that have got a hamburger and they were–
Dr. Sully: That’s an east coast burger, baby.
Howard: They weren't afraid of McDonald's. They weren't afraid of Wendy's. They knew Wendy's and McDonald's and Burger King were in every corner, but they opened up right there across the street from him ready to go and I guess, were they doing good? I don't care what you do. The first thing either you start measuring it. I'll walk into a dentist office and say, "Hey, Sully. If a 100 people argue in the cavity, how many do you close and convert to drill, fill and bill?" And they slay you with their eyes. Okay, so if you don't know you're getting an F or a D, what's the first rule a day a meeting? You have to admit you have a problem. You have to go in there and say, "Hey, I'm Howard and I'm an alcoholic." You have to go in there and say, "I only got a 38% closed rate". Then you share that with your team. Like, we know in our team – we can line up everybody. We have a packing order on whose eye is closed, right. I mean my thirty-year dental assistant, Jan, I mean everybody in the office wants her to do the job, but sometimes she can't. She's busy; she's doing something else. So, then who would be your second go-to person? Well, we'd want Dawn. I don't even make the top fifty percentile, and I'm a dentist with an MBA. The alphabet soup shit means nothing. The terms we use; 5,000 words of Latin and Greek they don't even understand. I would start measuring it first, then I realize, okay if half of our patients have bought a $30,000 new car, what's the difference? Well, you see the car it just says 30 grand. Then you sit there and you'll see if you can get approved. A lot of these people get approved before they go in there, but you know you're walking into the room and just saying, "Hey, gosh. Congratulations, man". We can do the whole thing, the whole $30,000 new car for just $450 a month for 60 months. Is that something you wanna do? 10% of the dentists can do that every single month. It's at least 10%, and you had a great guy on your podcast, Danny. I mean, Danny Dominique. Where's he from? Beverly Hills? Manhattan? New York City?
Dr. Peyray: Louisiana.
Howard: He's from Lafayette, Louisiana,where the shoes you're wearing is what they wear in church– Sandals, slippers. This guy is doing that every other day in Lafayette because he's good-looking, he's charming, he's succinct. You know what we do is – about the only thing we do just -- if we just took out all the teeth and place just four little implants for the denture on there, it looked like a Hollywood smile, it's $25,000 an arch, we could do the upper and lower. Is that what you wanna do? He's just all good-looking and shaking your hand and you're like oh yeah. Yeah, it looks like I'm not gonna be able to buy that F-150 Ford pickup truck this year. I'll have to buy that two years down the road. That's your competition not Heartland and Aspen and Pacific across the street.
Dr. Sully: So, the next thing I wanted to hit on before we wrap up our transitional –
Howard: Dude, are you hitting on me?
Dr. Sully: Hang on, just a tag. You look bald for my taste. The student loans are the biggest thing that's everybody is terrified about graduating. You graduated and bought things in the era where it was like, you know 12% interest only or 15% whatever. Yeah, student loans are high, they're getting 78%, but we see that over and over and over be a big fear and it is a reality, but a big fear of holding new graduates back. So, I'd love to get your thoughts on how do we deal with that and what are the ways to overcome that and look past that to continue to invest in yourself and your practice and make yourself grow but managing that too.
Howard: Hey –
Dr. Sully: And the retirement.
Howard: Is that a Dr. Hosley, you're coming?
Dr. Sully: No. How are you, sir? Participation maybe.
Howard: Participation? If you guys need –
Dr. Sully: Peyman will take this. We’ll keep going.
Howard: I would say this, that the number one student loan debt is not anyone's from. The only problem that you'll ever have lives in between your ears. It's all these self-limiting beliefs. You're your own worst enemy. No one else is gonna be your enemy. You’re talking about a $350,000 student loan. You think that's bad. What percent of that class will eventually walk out there and buy a house someday that cost more than $350,000?
Dr. Sully: Most of them.
Howard: All of them. What percent of them will get divorced?
Dr. Sully: Half of them.
Howard: Half of them. What's the average divorce cost in dentistry?
Dr. Sully: Super expensive I imagine.
Howard: I’d never seen one under a million. Mine was 3.8 million.
Dr. Sully: Oh, gosh.
Howard: It was eighty-seven times – whatever. Let me tell you it was a - I should know this number now.
Dr. Sully: You have probably a bit about that at all.
Howard: But the bottom line is – Ryan, take 3.8 million divided by $87,000. I'm just curious myself. My divorce cost me forty-three times more than my damn student loan deal. The reason you're not opening up a dental office, not because you have student loans, not because you're gonna buy a house figure that someday, not because you're gonna get divorced for millions, the reason is you know what to do. Start your own business. You've just decided not to do it. I'm fat. I know what I'm eating ice cream that I shouldn't be. I know I should never eat that shit again, but I decided I'm gonna eat it anyway. You know that if you have $350,000 in student loans working for Aspen and make it $125,000 a year and then paying taxes and then you get comfortable, so you buy a house and a car and start eating out three nights a week. That it's a trap and you're gonna be there forever. They pay you just enough to kill all your dreams. I mean they're like now you're coming home and your wife's pregnant, has a kid, and she's like, "Well, you make $125,000 a year. My mama only makes $25,000, and I don't know, it seems risky to walk away from that job and start your own business and why don't we just stay put and kill all of our dreams and you go work for the man for the rest your life". The bottom line you know you should started it off, so it's not the student loans. I mean you borrowed three hundred and fifty, but you can't borrow twice that amount to buy an existing office? It's just all in your head. I graduated May 11th of ‘87 and my office saw its first patient September 21, '87.
Dr. Sully: That was a couple of months.
Howard: I'd only had done like 50 fillings. What was it? Fourteen units of endo, ten units of removable, I mean –
Dr. Sully: Well, my thing is too is like you're investing yourself. Like if you look at one thing and the default rate on dental practices is like super low.
Howard: It’s 0.4% so 99.6% make it with a 0.4% default rate.
Dr. Sully: Yeah, that's me like right there. It's huge and as you said, the idea of learning like $350,000 a lot of money, but the reality is we're both over a million dollars in debt now between you know practices and houses and things and so it's like learning to kind of be comfortable with the debt is good. The other thing I'm saying is that I'd like to touch on in which – I think part of the problem is we have a lot of your age group, like my dad who is not –
Howard: How old is your dad?
Dr. Sully: 54. 53.
Howard: God, I'm assuming he's born in – I'm 54, so I'm your dad.
Dr. Sully: Yeah. I think you graduated ’88.
Howard: I’ll be your other dad.
Dr. Sully: Yeah, if you know that. Papa Farran. That generation is now starting to get on cruise control slash you know going down. They're not investing in their practices, they're stopping to invest in technology, they're trying to tighten up because they haven't done well in retirement and so they're trying to get rolling because I think they're gonna take home more and so now you have - they're less willing to hire associate dentists. So, there's not a lot of associate ship type practices that it seems for new graduates to get apart up. Do you see what I'm talking about or do you do you think that's an issue?
Howard: I would say this. When I was a little kid, you always heard all your older grandpas and uncles and everybody in the community there's a big conspiracy theory that the only reason America always went to wars because it was so good for the economy. Well, World War II, you destroyed Germany and Japan. Those are the only two countries that made cars and refrigerators and anything you wanted to buy. So, that was really good for the American economy. All the wars since then, you've gone on war with countries that don't sell one thing at Walmart.
Dr. Sully: Don't make shit.
Howard: So, wars are total expense. I'm all for war if it's against all the countries that make everything at Walmart, okay? If they didn't take anything at Walmart, you're wasting your damn time. The point being after you destroyed that competition after World War II there was this massive expansion of wealth because the only place that wasn't leveled and you could buy anything was The
United States. Well, they still think that they were the greatest generation and they think we can go back to that time. They act like Germany and Japan don't exist. Now it's not in Germany and Japan anymore. Hell, it's Italy and France and Denmark and China and India. I mean everybody on earth is making - I mean Brazil sells airplanes. Can you believe someone can make an airplane wearing a thong? I mean every country is making amazing shit that's showing up everywhere in the world. So, yeah this post-war to that from 1945 you just do your time forty years, and the Fortune 500 get your pinch and go home and play. Those days are completely gone and they're never coming back unless there's some massive war in Europe which there could be. They did twice last century. I mean if they did it just one more really good time this time that you know maybe those days could come back. Then you have China already out producing and them. You would need the whole eastern hemisphere to go up in flames to return that mentality from 1945 to 1980, and it's gone and it's not coming back. So, those dentists are gonna basically - when do you think a dentist gonna wake up someday and say, "You know what? I never need another dollar again". He's thinking sixties thing, "Oh, I'm gonna retire sixty-five." Then at sixty-three, his wife says, "Let's do a cruise in Italy." Okay, we'll retire at sixty-six. Then at sixty-five, she's like, "You know, we need to replace our cars." Then just when every man thinks the house is finally all fixed up, what does your wife say you know? You know we need new furniture, and let's paint, let's remodel because everything's perfect. So, let's just destroy $50,000 in capital and put all new, different colored shit in the house. So, it never ends. It's the pattern. It's the pattern behavior. So yeah, these guys aren't gonna retire. I did a de novo. I would say financial things that bother me about millennials is like Arizona has two dental schools. They're both private. They're very expensive. These kids are coming around they're at 3:50. There's a lot of Mormons in Arizona and Utah. They come out with two kids, and they're $550,000 in debt. Their mom and their mother-in-law live right up the street and it's like, "Okay, dude. You need to go back home, and you need to live with your parents, and you need to drive a thousand dollars jalopy, and you need to start your own office. You need to live below your means hardcore, for ten years". Oh, hell no. Well, I've already got two kids so I need a five bedroom house and I was $500,000 then I got a $500,000 house and my sweetie wants the hottest SUV because she doesn't want to pull up in the LDS parking lot the only one not driving a new suburban and they just live so far above their means. Then you do with this technology stuff. Your dad - here's how my walnut brain your dad - we buy a $17 Impregum Impression from 3M. We send it on three he makes a $99 zirconium crown, and we cement it. Here's what you do. "Well, why would you want a $17 impression when you can have a $17,000 3M true definition scanner because dad's not investing in technology". Why'd he sent it to the lab man for $99 when I could buy $150,000 CAD/CAM machine and mill it chair side because my lab man he's made 10,000 crowns in twenty years, but I've never made one. So, my best ideas I should make them. Or I'll have my assistant make them because she's never made a crown either. 2D pano, how does an orthodontist - If an orthodontist can't do ortho with the pano and a ceph. What does he need? Ouija board? Well, I think I'm just gonna get $100,000 another CBCT. You guys buy every, gosh, darned piece of technological needless shit every time you turn around, and that's the other thing I see. When you see a Boomer like me driving a Lexus, It's paid for.
Dr. Sully: Yeah.
Howard: When you see a millennial kid driving a Lexus, it's probably leased or it's on a five-year payment plan. It's just living beyond your means. A fool and their money always parked. In my thirty years of dentistry. I'm in Phoenix. I'm across the street from the Guadeloupe Indian Reservation. Lots of people over there, dirt floors, undocumented workers, a lot of them are from Mexico coming and going. I've never had one not pay their bill in cash. Who are the only people that jerk my chain? Millionaires. So, your daddy is 54. He's got bank so he ain't parting with it. A millennial doesn't have a dollar. They got five hundred thousand student loans, and it's just all negative, so why not just add more?
Dr. Sully: Yeah.
Howard: They spend money they don't have. If you walk into a study club and you say, "I think the fastest, easiest, cheapest way to do a crown is just with three burs. A triple tray impression and send it to old man Frank up the street for $99". He's like, "Well, you're just kind of a horrible person and a dick and a bad dentist." I bought an oral scanner and a CAD/CAM machine, and I send my x-ray to Denmark and blah blah blah". He's like, "Yeah, dude." You're gonna be paying interest on other people's money when you're 60. I wish a millennial was synonymous with the word minimalism. I wish millennial meant minimalism. They lived at home. They drive used cars. They saved their money, but they just seem like they part with that money more than any generation I've laid eyes on.
Dr. Sully: No we're bad about that. We want it. We want it now. We don't want to wait for it. We feel like when we graduated, we earned something. If I got somewhere really, we're just getting a square one. Now I think I disagree a little bit with like some of the technology and that I feel like especially the older dentists who are cruising though. If you're gonna stop investing in the technology, eventually you're going to get passed by our generation because we're gonna be able to do it faster, cheaper, better and that's what patients will want to.
Howard: Okay. Name the technology that's going faster, cheaper, better that the old people should get.
Dr. Sully: Well I think the Same-Day Crowns is one that's gonna be in the city.
Howard: That is so bullshit. I've been a dentist for thirty years. When I tell anybody in Arizona that needs a crown, they only got two questions. "Oh my god. I'm afraid are you gonna give me a shot?" Or, "Oh, my God. How much is that gonna cost?" All they see is your cost and all you hear is they want it same-day.
Dr. Sully: Your point though is - that's a thirty year. That's the past thirty years. I think the next thirty years are gonna be - I don't want to take off work as two days I'm losing money. I need to be able to come in and get the crown done and be gone. I think that's the future we're going to. That's how and along with that is the same way our generation. We call, we want something. We want it now. If you don't answer your phone, we're going to the next dentist, the next person.
Howard: That I agree with a thousand percent.
Dr. Sully: I think we have to start to think about how we're doing dentistry differently a little bit just because the consumers changing.
Dr. Peyray: I'm gonna say this, Howard. I tend to disagree with Sully in disregard of as far as the same-day crown. I love the technology but the same-day doing something and Howard said it from trying to do something that the lab guy did for so many years and trying to replicate that in to do it yourself or teach, train your staff to make these crowns. Especially when you start talking about aesthetic or anterior because I don't think it's worth it. I honestly don't think it's worth it. In the long run, I don't really see it. I would say if you could make a good relationship with a lab and become that $90, $95 because that's what I do. I'm getting my crowns for 80 something.
Dr. Sully: Yeah, but it’s also numbers game too from a standpoint of like the volume you're doing for one.
Dr. Peyray: No. I'm talking about doing the – yes, but Howard saying thinking the long run when you have a practice that's established.
Dr. Sully: Howard, when was the last time a lab guy sent your impression back and didn't send the crown back?
Howard: Send the impression back and not the crown?
Dr. Sully: They called you and said I'm gonna need a new impression.
Howard: Oh that's something that you get better at. Let me get a run on that.
Dr. Sully: My point though is like I think the one thing that's nice about like I came dentistry
and obviously. I see your point that the lab guys make crowns for twenty years and so he's gonna be better at that, but the difference is it's like they can also make your shit do better and so I think that one of the benefits of doing milling your own crowns some of that is it makes you a better dentist because they're not sending. The majority of labs aren't sending because - if they are sending back every impression that sucked because they're making it work, right? They're figuring how to make it work so that you don't have to because then you're gonna find in the lab that's gonna do this. Do you see my point?
Howard: What percent of your friends – you’ve been out of school for two years. What percent of all your classmates are right now in associate position?
Dr. Sully: What would you say? Probably 35%?
Dr. Peyray: Most of them.
Dr. Sully: No, a lot of them are in corporate.
Howard: I mean an employee somewhere.
Dr. Sully: Okay, let’s just say 60%. Let’s say 60% are employees.
Howard: 60% are employees ,whether it's for dad, private sector, associate.
Dr. Sully: Sure.
Howard: How many of that 60 % are happy and say I want to stay here forever? Or do they have major issues within the work for whether that's private or corporate or whatever?
Dr. Sully: I probably say 20% of those [46:08 unclear]
Dr. Peyray: I would say half of them– Half of them are happy. Half of them become content as time goes on. They just get used to that style of dentistry. So, it's just very hard to say.
Howard: You say that half of them aren’t happy.
Dr. Peyray: Correct.
Howard: Is that any more likely to occur at corporate or private or this is about the same. Same ratio?
Dr. Peyray: I would say it would happen more in a corporate than associateship whether that's if you know somebody.
Howard: Yeah. The doctor they're working for they say, "Man, that's just a humble, laid back guy. I really like that guy. He's a mentor mine. I can go to him with any problem question". Versus having him say, "He's a dick".
Dr. Sully: I'd probably say 10% where the mentor of that half group. I would imagine that. Dr.
Peyray: One out of four, I would say twenty-five.
Dr. Sully: The majority of them probably don't have that ideal relationship.
Howard: Yeah. Okay, so the bottom line is the natural selection. When you have to get A's in Calculus, Physics, Geometry, you got some guy who sat in a library. Learned all this shit. Thinks he's all that in a bag of chips and these lab people every single one of them is afraid of you. You're a doctor. Hell, just go walk up to a stranger in the street and say, "Hey, can I ask a question? I want you to describe not a doctor, not a lawyer, but a dentist. Describe a dentist in three words". Listen to their three words. Arrogant, condescending, asshole. So, these labs can't call you up and say, "Hey, you're young and out of school. I could show you a few tricks. I've made twenty thousand crowns. You gotta come over". They're afraid you're gonna say, "What? My crowns not perfect?"
Dr. Sully: Sure.
Howard: You're an idiot. Retake the impression, you Neanderthal. I'm sending it to someone else. I want you to use a lab that you can drive over there too. You have to establish your likability and trust. You got to go there and say, "Hey, how are you doing, dude? I'm two years out of school. I don't want to send my lab clear across the country to somebody I can't talk to. I want to come in here and I want to tell you that I'm sure anybody who's done a hundred times more crowns than me, learn something I didn't learn". Then they worked for me. That was an old German guy. Oh, my gosh. What was his name? Wolfgang. God, dang. He's 87. I wonder whether that guy's alive. I hope he's not alive and hears me just ask that on the phone or the podcast. I called him, and I said, "Hey. How did my impression look?" It was just like dead silence. He's like, "Do you have a question?" I said, "Well, you know I went to the University of Missouri in Kansas City. There's guys out here from UCLA and USC. Is it good?" There's like a dead pause.
Dr. Sully: Blown away.
Howard: And he was afraid to say anything. So finally I went down there, and he spent like half a day he worked. I mean there's a hundred in (inaudible 48:54). Shown me all this stuff and he showed me the death guys. He taught me one perfect lesson. He goes, "You know why I had to send you a reduction culpit? I said, "Because I didn't reduce enough?" "No. Because you took the impression before you made the temporary. You could not have put a on that tooth and adjusted the temporary and not have drilled right through the temporary". But what did you do? Lazy. You took the impression left, and you had Jan make the temporary. Jan took 30 minutes to make temporary. You and Jan could have made the temporary together in four minutes, and you could have worked out. If you can't see the impression on the temporary, then how are you gonna find it in the Impregum? If you don't have the reduction in the temporary, how are you gonna – So, Jan and I listen to this guy, and he said you only need three burs blah blah blah blah and we would sit there and do the prep. We pack a zero chord. We pack one chord. We'd make the temporary and sometimes you take the temporary off your trim. The temporary would loops on you're like, well where the hell is the margin? Well, it probably it's doesn't exist. You can see that better on a white acrylic temporary than you could on a dark purple Impregum. I still don't know why. Why don't they just change it to black? They're only like one color away from the worst color of reflection of light.
Dr. Sully: Do they even make a like a low light body either or something that goes with it or is it just the purple Impregum?
Dr. Peyray: No. There’s a light body with the Impregum.
Dr. Sully: We still use it ‘cuz I work with a 54-year-old.
Howard: Yeah. The shit works.
Dr. Sully: It tastes terrible.
Dr. Peyray: And worse. How about the polyether? It’s good. It’s rigid and actually for temporaries. I tell my assistants to use it for temporaries. It’s so snug when you put it on.
Dr. Sully: So, you're not anti-technology. You're just saying that basic look -
Howard: I'm not anti-technology. Buying a CAD/CAM is exactly like buying a Steinway piano. When you get that piano delivered, it's gonna take you ten thousand hours to learn how to play Beethoven. Your lab man already did the ten thousand hours and a lot of dentists you say, "Do you like lab work?" "Hell, no. I hate lab work, but I like technology". Okay, that makes no sense. If you don't like it, then you tell your assistant to do it but what I'm looking at is you bought this $150,000 piece technology where every two or three years, you need to come back and give them six thousand more for whatever.
Dr. Sully: That’s true.
Howard: You buy this oral scanning technology and they say, "Well, yeah. We need a $200 a month in perpetuity for your lease up wear updates". 200 a month? Shit, I'm not buying 200 a month on Impregum. Now, I just have to get 200 a month just for my update bullshit, and I'm still missing $17,000 that if this market tanked tomorrow, wouldn't you like to buy $17,000 of Google or Facebook or Apple if it tanked tomorrow? No. It just seems like every time a millennial has a great idea, it always involves a shit load of debt. That's why I tell millennials just quit thinking.
Dr. Sully: That’s true.
Dr. Peyray: That’s true.
Howard: In fact, I joke to the millennials. They should go into the dental office. Have a big, old whiteboard every morning at the staff and they'll say, "Hey, I woke up this morning with a great idea and I'm gonna write it down and I pay you guys not to let me do it. Okay? This is my idea". And it always involves debt, credit card, leasing, buying, and here's my idea. Why don't you go in there in the morning say, "Hey, we work sixteen days a month and all of our bills for everything. You, me, everything. We have to do $2,000 to break even. So, let's go do 2,000 and then we'll go to lunch". Millennials will say, "Well, we had a cancellation eleven to twelve so we just sat around on Facebook and then at twelve, we went to lunch because we're entitled like the government". I'm like, "You're entitled to going to lunch at twelve? You didn't even pay the bills yet". If you had a cancellation at eleven, why don't you eat a banana right then because someone's on the phone 11:30 and they said they could get here at noon and we told them they could come down. We don't give a shit about your lunch hour. We're gonna hit our BAM number. Bare ass minimum break-even point then we can take a break and then we're gonna come back and do it again. If we come back and do it again, we got 50% overhead, but I go in there. They get in there at 7:30. They don't even turn the phones on till 8:05. They're going to lunch at twelve to one even if the entire morning canceled and no showed and they're leaving at five even though the doctor might lose money for the day. If you want 50% overhead, you know what to do. You just decide you're not gonna do it. You decide, "Well, you know it's fair that since I got out of dental school I should get a new car. It's fair that I should eat lunch from 12:00 to 1:00 even though I'm morbidly obese".
Dr. Sully: I think it's not generational though. I don't think it's just millennial. I think that's all dentists. I think the majority of dentists aren't looking at those things and doing those things. I think that's why most dentists are retiring. Why most dentists are working at sixty five because they're doing all those things you're saying. I think the difference actually with us, the problem is, with the world we live in now with social media, the access to information; all the shit millennials do is just now it's broadcast to the world. So, I feel like the 10% that do really stupid stuff end up becoming the name for the majority of us, right? But the flip side of that though is –that's where I say and I know you joke and laugh, but I'm telling you there's a lot of really talented millennials out there. Who are young dentists who are gonna utilize a lot of this, the access to information. What we can learn now, you had to fly somewhere, do something and I'm not saying that going places is bad. I'm a huge advocate of that but our access to information is incredible. So, if we will actually use it and utilize it, we can get really good really quick and really help ourselves improve to where that I think that's where the older dentist is going to be careful because we're gonna make ourselves a lot more attractive to patients because a lot of things you're talking about, they're not doing.
Howard: I agree with the transparency thing because like people always say well poverty is related to crime, well how come we didn't have any crime during the great depression from thirty two to thirty six? Because no one wrote it down. Someone come and stole your cow, how would we know that? You know what I mean?
Dr. Sully: Right.
Howard: Yeah, I think all people are the same. I think millennials, the difference between millennials will be it's that generational pattern. Everything's next generation is not doing good. I think that every generation gets smarter. Hell, in 1880, 80% of the planet couldn't read or write. Now we have four and a half billion and a seven and a half billion people living in a house with a smartphone with fifty-two million pages weekly. I think when Jobs stuck the internet and the smartphone from 2007, that next hundred years will be the greatest century we've ever had because we're gonna go from illiteracy to literacy. I do think this is undeniable about millennials. When I was a little kid, every farmer I knew worked sun up to sun down on their farm seven days a week. Every dad I knew that had the eight to five job as whatever had a weekend job. One of my friends I went to dental school with from the 7th grade to the dental school, his mom and dad were both a pharmacist, and they both had part-time jobs. They were pharmacists and I see you go to higher associate.
Dr. Sully: We act entitled.
Howard: As an associate say, "Well, how about two nights a week you stay until seven". "What? I'm not staying till seven". "Oh, how about one Saturday a month you come in for four hours?" "Hell, no. What do you think I'm an idiot? You want me to stay till seven and work one four hours Saturday a month? Are you out of your freaking mind?" It's like, "Dude, your grandpa on Sunday would get up his sun up, and he had farm chores till he couldn't walk and it was dark and he couldn't see, and you can't do one four hours. I'm telling you, a lot of people say the millennials have less children. Later in lives, they're gonna have less kids because they treat a child as like an economic purchase. They'd rather have vacation and condo. I say the birth rates declining with millennials is because they're too lazy to fuck.
Dr. Sully: We're working too hard. This has been fantastic. I think so many of this stuff is - I'm excited. The financing thing, I'm going back first thing Monday morning and we're going to reevaluate that. All this stuff has been really, really important.
Dr. Peyray: Words of wisdom.
Dr. Sully: Appreciate all that.
Dr. Peyray: Everything you said is so true. I cannot agree with you on every single subject as far as what the pattern is. Especially the pattern of how this generation is not really a generational thing. It just keeps coming and going and just the way that everything you explained. One quick thing I like to ask you and I don't know if you mind sharing with me the future of Dentaltown and the future of Education and CE online versus what you want to do with the whole DentalTown.
Howard: That's a great question. My generation, if you wanted to learn from Carl E. Misch. You bought his damn textbook for $118. You read his textbook. Your generation has to fly across the country, stay in a resort, drop $5,000 for a weekend. Like on DentalTown.
Dr. Sully: But it’s a write off.
Howard: We put off four hundred and fifty courses and some of these. People don't realize this but that endo continuum that's like twenty one hours long cost 1 million dollars and a decade to film and tape. You can buy that for less than the cost of flying Southwest Airlines to whatever institute you're going for.
Dr. Sully: Yeah.
Howard: It seems like every time they want to learn one thing. They'll come back from an
institute. They drop four grand on the weekend on TMJ and I'll just sit there at the bar saying, "Hey, here's a piece of paper. Here's a pencil. Just please just write down everything you know now that you didn't know". They can't even fill up a page.
Dr. Peyray: Absolutely.
Howard: I'm like, god. We could Google Amazon books and type TMJ. There's a gazillion TMJ courses on DentalTown for 18 bucks, but the way you did it cost four grand.
Dr. Peyray: It’s so true and it's funny that you brought that up because I get a lot of people ask me about the implant. My age, my group, a lot of my colleagues ask me about, “Oh, what's the next implant course? What’s the best implant course?” There are so many of them these days. So many organizations, association and my number one thing I tell every single one is what you said about buy Carl E. Misch's textbook and you start reading a little bit about just the terminology, vocabulary. What abutment is? What's impression coping and know a little bit more than before you go to any of these weekend $5,000 courses because not only that $5,000. You might not even use it because again we go back to like having the patient. Having all that implemented in your practice before you do any of these sort of CEs spending five grand, but at the same time education, the textbooks and things like you said 17 bucks that you could get on a fingertip on Dentaltown. Those are some of the great things a lot of young dentists could use right out of school.
Dr. Sully: On the same lines I feel like the other issue kind of whiskers back to the five thousand resort and all that is we also just want to live in the city. You think with $300,000 debt we would be willing to go work in rural area and make bank and pay that off and they move around and we don't really –
Dr. Peyray: See, that's problem with rural areas right now. Dentistry is amazing. I feel like there's so much money you could make. Had a prosthodontist friend who called from Montana and he was asking about a denture clinic and extraction. I was like, "Dude; I want to get on this with you". Because I already know it's a great, great thing to do in a rural area. You can do so much money.
Howard: Here's another one. Not only are they lazy and entitled, but they also won't work pacified. They won't come in on a Saturday but look at their grandparents. Their grandparents came from another country with the shirt on their back. In their land, they didn't speak the language, and you can't go a mile away from Memphis. That's lazy.
Dr. Sully: The good part though is entitled and - what was the other word you said we were entitled and what?
Dr. Peyray: Lazy.
Dr. Sully: Lazy.
Howard: So, you’re lazy to remember the word lazy?
Dr. Sully: I got a guy (inaudible 1:01:32) screw you. Well, but like as entitled as I am and as much as I want it now, that's also one of the things I think that those of us that are very, very successful that's what drives us. Because you know what? Yeah, I want it now, and I don't have a problem with that, but you know what I'm gonna do? I'm gonna go freaking get it. So, I think there's a difference between some young dentists and some millennials, whatever you wanna call them, that there they are entitled and lazy, and they want it to just come to them but the same time there's a lot of them that's gonna be, it's gonna allow, it's gonna push them, and I think that's where we're gonna be really successful because we're gonna take advantage of exactly what you said. We're gonna take advantage of the fact that we can get a full-on endo continuum on Dentaltown for not much money. Or that I can watch tons of YouTube videos on how to do locator dentures or you name it. So, the flipside, I get that part but my thing is to is like, "Man, if you're a young dentist, take freaking advantage all this because we have the opportunity to be so much more educated and learn so much more quickly and make so much more money. So, earlier in our career that y'all did because of the access to information.
Howard: Yeah. You know everything's gonna pass my four finger test. Is this the fastest? The easiest? The lowest cost? And the highest quality? I did a podcast yesterday. It was occlusion TMJ guy from Canada. He’s written four textbooks and you can buy them all for $99. A millennial wouldn't consider that. They’d say, “Well, wouldn't it be easier for me to just fly to Canada and stay in a resort and go skiing at Banff on the side and then miss half his lecture?”
Dr. Sully: So really, that part he would probably be like, “Well, that doesn't sound fun and flashy and entertaining. So, if we want to go take the implant course we –
Howard: Let me tell you about implants because it's the same pattern. It's not right or wrong; it's just the same pattern that we talked about earlier. Don't send your crown and bridge across the country. Find somebody who's done 10,000 crowns in your town that you can meet with and when you show up there call them and say, you gotta pretend you're humble. You gotta say, "Hey. You want me to pick up a Sub sandwich and a couple of tacos? You want a Wendy's burger?" Just something so he realizes this is actually that one human dentist that we kept hearing about that would show up one day riding a unicorn, dating the tooth fairy and get a relationship and you say, "Look. If you can make me better, please let me know". Well, that's how you learn implants. So, in Memphis probably two-thirds of all the periodontists, oral surgeons think in fear and scarcity. They don't want you to learn that they just want you to refer to they're like - look if you want the implants right, you send them all to me because I'm an oral surgeon and you're a Neanderthal. I've done things – I did implants from where you are born. One-third realizes this pattern which is a very interesting pattern. The number one thing you learn at learning how to do Invisalign and implants is you become a better diagnostician, and you see it, you train, it's on your head. Now every dentist eventually figures out that whatever you learn if you don't do it at least one time a week, which is fifty times a year, you're never gonna make money at it. So, you get into sleep apnea. Well, if you better do a sleep apnea appliance every week because if you're doing one once a month, you're so slow, inefficient, you lose money. Same with the implants. You can't place, you cannot make $1.00 in profit placing twenty implants a year. You're not fast enough, good enough. Every time there's implant out your systems like, "Okay, now what do we do again?" and your failure rates off the chart. What if you needed a vasectomy? Would you wanna go to some guy who does it every day or every other month?
Dr. Sully: Every day.
Howard: Yeah. So, the litmus test for profitability is once a week. Well, the really smart thinking and hope growth that abundance periodontists, oral surgeons in north and I say all know that. They know that everybody that went to Richard Lits and Brock Rondo and Sheridan and Harry Greene, everybody got into ortho two years later like screw this I don't wanna do it. So, they're sitting there. I know orthodontist who will tell everybody in a one-hour drive, "Hey, if you wanna learn Invisalign I got a little Invisalign study club. It's a first wins every month bring your cases I'll help you". Because he knows you just want to do crown and bridge and fillings and root canals and you're not gonna be doing Invisalign and even if you do them, now he's got a relationship with you, so you want to learn how to place implants. You don't need to go to goddamn Dominican Republic. You tell me no one will teach you how to place implants in Memphis, Tennessee for free, are you shitting me? A lot of this periodontist, they wanna extend their social network, but they're afraid of their own shadow. They're introverts or geeks, scares them when they even see themselves in the mirror and now you're gonna be their friend? They'll say, "Oh, yeah. Well, I'll line up my surgeries on your day off or the time that's whatever". Then you meet their rap and then cheese and then you get this social network. I mean you should be able to learn all your Invisalign, all your implants without driving one hour from your house for free. But That's how our generation did it and those are some of my best drinking buddies on earth I mean the people I go get along with watching Arizona Cardinals game and eat a bunch of healthy wings are dentists in my zip code who practice across the street.
When two-thirds of the dentists across street live in fear and scarcity and all that you saw my patient. I saw your patient. Was it a slave? I mean is it chained up in your basement? How did this happen? I didn't know that you owned a patient. I thought you couldn't own anybody in the world. One-third of all those dentists – just like you two. I just love the fact that there's three homey dentists on Dentaltown who show up in a dental office and sit on the couch. You're already successful. You're already successful because what you just did– that pattern you can now go do it without that orthodontist learn Invisalign. An oral surgeon and periodontist learn implants. Just do everything faster, smarter, easier, higher quality. So ask yourself. Well, what's the cheapest way to learn endo? Should I fly all the way to California to Santa Monica and listen to Cliff Ruddell? Or should I buy the endo textbook? I don't like reading. What would be cheaper? The endo course online by the same damn instructor you know for 19 bucks. If you just start living by those rules is this faster? Is this easier? Is this higher-quality? Is this lower-cost? What do you think I learned more from? Going to Carl E. Misch sitting in his lecture for eight flipping hours or reading his damn textbook?
Dr. Sully: Probably reading the textbook.
Howard: What do you think was more organized? And which one had less jokes about his ex-wives?
Dr. Sully: I don’t know. Maybe the textbook might be the -
Howard: So, yeah. I would just really promote minimalism and the thing that you're gonna learn about minimalism is that when you buy a big house, it's a money pit. Everything you buy – well, I'm gonna buy a boat that'll make me happy. Okay, now you spend all your weekends trying to get your damn boat running. You got to go half the time you deal with your boat you're taking in, out, you're doing all this bullshit. You know, Janis Joplin said it the best. She said freedom is when you have nothing left to lose. And gosh, darn it. I can't tell you how many retired patients I had that had million-dollar homes and all that, all throughout Minnesota and North Dakota and Canada they sold freaking everything. Came down to Phoenix and bought either a trailer or a thousand square-foot one-bedroom, two-bedroom house. They say, "Oh, my God. I just feel free. I don't have to mow that big yard. I don't have all that shit to take care of; I got nothing but cash". Minimalism makes you happy, and these people that buy the biggest house, the biggest boat, the biggest car, the biggest Taj Mahal dental office, usually 20% of them end up at the Betty Ford Center, the other half end up divorced. They're eating Vicodin just to try to control their depression. They say you get divorced over three things. A third money, a third sex, and a third substance abuse. If you combine, if you start using money to buy sex it's even worse. So, it's money, sex, and substance abuse and a lot of those dysfunctions are because you're under a lot of stress. You're living in a rat cage and you just got this big nut you drive to work. Also on that BAM number when your staff is always gonna come to you on a raise because raises are always based only on astrology. They say, “Hey, the earth has just gone around the Sun so I need another dollar”. Okay, well in that journey when the earth went around the Sun when it started a year ago our break-even point number was 2,000. So, we went around the Sun and now our break-even point is 2,500 and wasn't that because you wanted all those instruments that aren't sharpened and you wanted this and you wanted that and you want a new autoclave. How come every time you come in here my break-even point goes up and then you want more money? Well, I'm gonna tell you this. Why don't we have the earth go around the Sun and if you can lower my BAM number, I'll give you more money. Are we doing everything faster, easier, higher quality, lower cost?
Dr. Sully: I love it.
Howard: You’re not going to lunch and until we hit our BAM number. You’re not entitled to lunch. I’ll tell you what. If we don't break-even till 3:00 o'clock and we close at 5:00 and at 4:30 someone calls up with a toothache, and we know they're gonna give us her credit card for root canal, bill and crown, somebody is gonna stay here and do that root canal, bill, and crown. Someone is gonna assist that doctor, and that assistant don't know how to check them out and take the money or whatever then someone up front is gonna stay because we didn't break-even till three. So, that two thousand dollars at the end of the day is nothing but net and then we're back to our goal. Then when we go through the month if we're coming up on the end of the month and we're not hitting our break-even point, then you say, "You know what. I'm gonna have to open up Saturday”. Yeah, I'm gonna open up to let you celebrate. It's a deal this is Monday, but I'm gonna go ahead and open up Saturday because right now we're gonna have to do $4,000 a day for four days. It's not gonna happen I'm gonna blow up on Saturday and then they might start saying, “Well, how about this. How about we just do it Monday, Tuesday, Wednesday, Thursday. How about we're just gonna do it. We're gonna sell the treatment, we're gonna collect the money, we'll work through lunch, we're gonna stay late because a millennial would rather go to hell than come in on Saturday”.
Dr. Sully: That’s probably true. Well, I wouldn't know. We just got to do that and that's part of it’s tricky because that's counterintuitive to what the rest of our friends and other millennial buddies are doing. They're living on debt doing that stuff so it’s kinda tricky but it is what it is. Well, dude thank you so much.
Howard: I'm so proud of you guys. I love your - oh and I want to make one more point about this.
Dr. Sully: Okay.
Howard: So, you know that you think different than me, a baby boomer. You know that the generation ahead of us, they call that the Silent Generation and the one before that were the Greatest Generation, whatever the hell. I see these website bounce rates like I fall in love with you guys on this podcast. It's like we're in the same room. This is something I never thought was possible when I was in dental school. Then I go to your website and it's like a mug shot when you get your DUI. Like ten people go to your the for one that converts and calls the office. You millennials, you like Yelp. I've never even seen Yelp. I've never seen a baby Boomer dentists in my life. I could imagine sitting at the bar with Tom Madden and Tim Taylor and say, “Hey, you want to go to that restaurant?” “Well, let me Yelp review it first”. It's a totally different world, but when they come to your website they should get this experience. They should get your karma. You shouldn’t be sitting on a couch and saying, “Hey, let me tell you five reasons you should come see me. You're not gonna find anyone better looking that's obvious. You're gonna find no one closer. I'm in Memphis. How close could you get? You live in Memphis?” Just make it fun, make them laugh, make them giggle, make them say.
Dr. Sully: Sure.
Howard: In 60 seconds establish likability and trust because all they want to do, they just don't want to get sold a transmission fluid change they don't need. They don't want to buy a new air conditioner they don’t need. They just want you to fix it up and if they like you and they trust you so go to the video on that. Then measure it. What is your bounce rate? I mean there are dental websites that 100 people will land on and not one person calls. Then he says, “Well, what do you recommend for marketing?” Well, why don't you get your bounce rate from ten people land on your website to one calls. Why don't you maybe get it five people lands on your website and one calls and then when they called you measure that. No. Well, most dental offices, three to four people have to call before your untrained receptionist who you named her entire career after a piece of furniture. “You're the front desk and you're a piece of furniture”. In every other business they’re incoming telemarketing. So, then you measure. "Okay. So, Valerie the you got a hundred phone calls and only scheduled 35 appointments. I think I have a hundred phone calls you can have”. Then I asked you the conversion rate. Well, half of them went to voicemail. I asked you, “How many of your calls went to voicemail?” No idea. “Well, how many that went to voicemail did anyone even listen to?” No idea. “What are you doing this weekend?” “I'm flying to the Pankey Institute to learn how to adjust canine guided occlusion”. Really, that's your biggest problem? Ten people on your website for one calls, four people call before you get one ass in the chair and three people are told they have a cavity and only one gets it done. So, to do that one cavity I need three people in chair. To get three people on chair I needed nine people to call. To get nine people to call I needed ninety to land on my website. And your best ideas that you need to get some alphabet soup title behind your last DDS name?
Dr. Sully: Yeah, so true. That's pretty –
Howard: So, then your hygienist sees eight people. She wants a raise ‘cuz the earth went around the Sun one time. It's all based on I guess Magellan or Pinocchio or whoever and -
Dr. Sully: Pinocchio.
Howard: She sees eight people, but she only schedules for a recall. So, she just lost 25% of your business in one day and wanted a raise.
Dr. Sully: Of her portion, yeah.
Howard: Yeah. So, what's her reappointment? She doesn't want to schedule the appointment because she knows she sucks so she's gonna hand you the chart to the lady named after furniture and say, “Hey, front desk lady. You schedule for a recall”. Then the front desk lady says to you, “Well, you wanna schedule six, one, three call?” “I’ll call you”. That's why when the average dentist gets up to five thousand charts, four thousand of them don't come back. No, hygienist. I'm paying you forty bucks an hour. You schedule your damn recall because incoming calls, I don't know when the phone's gonna ring. When that phone rings incoming telemarketing needs to take that call and try to convert them to an appointment. You scheduled recall and furthermore, you're the one getting $40 an hour so I want to see what your close rate is. I'm getting him reappointed. How come I got two hygienists and one can reappoint 95% of her clients to come back in three, four, six months but half a year’s never wanna come back. Maybe you're a bitch, maybe you talk down to people, maybe you just talk about yourself. Why don't you go get your hair done? Listen, you should only get your hair done by a cosmetologist that you can't get into that will tell you, “Yeah, I've had these hundred ladies for ten years”. Okay, I want to see some of that. I want to smell that. They're not talking about their husband and his dirty laundry and their babies. They're talking about you and your family and your babies. They're on stage, man. I mean when you go get your mani-pedi done, they always say, “You want the sea salt rubbed in?” Where did this come from? What homo sapien decided they need sea salt rubbed into their calves? It’s that whole experience of “I like you because you're talking about me. You're not just trimming my nails, you're rubbing sea salt to my calf and I get to vent to somebody about how horrible my husband is and my children and my neighbors and the life is so horrible, whatever”. You need staff like that. You need staff like they're doing the mani-pedi, like to cut in your hair. That's the staff you need.
Dr. Sully: Ultimately, basically this all boils down to become be a likeable person who can communicate well. You and your whole team and staff and the 99% of the problems were worrying about are gonna slowly fix themselves because we're focusing on the wrong things.
Howard: You'll hire your front desk you'll say, “Well, I'm gonna hire Susie Q. because she has ten years experience. I'm like, “Okay, well let's talk about her last practice. What would that look like?” “I don't know”. “Well, did you talk to the nurse?”
Dr. Sully: Yeah, what’s your experience?
Howard: “No. Actually he killed himself. After he committed suicide she decided to come work for me. So, I figure I'm about ten years from hanging myself with rope”. I don't even want experienced staff that came from a horrible experience than office. I'd rather take the hottest mani-pedi chick who has five hundred women been following her for ten years and no one will - I'd rather get her and teach her the computer in dentistry. I'd rather get the best gosh turn the girl that no one can get into to get their hair done because those are the ones who have the - I don't like calling it the new patient experience because it's got to be every patient every day.
Dr. Sully: Right. I love it. Holy cow.
Dr. Peyray: This has been a great episode.
Dr. Sully: I know. This is exactly what I wanted because we've gotten nugget, nugget, nugget, nugget, nugget, nugget, that we need to be –
Dr. Peyray: I love nuggets.
Dr. Sully: He love nuggets.
Howard: Chicken McNuggets.
Dr. Sully: Exactly, yes. We will take and implement –
Howard: We call this incident absurd. Chicken McNuggets.
Dr. Sully: Chicken McNuggets with Howard Farran. I like that.
Howard: You're 51% dentist and you're 49% people-person. Bottom line. You don't need more dental technology, expensive overhead shit. You need to learn how to attract and retain the best employees and that lady up front is the most important person in the office because she's taking inbound calls. The only person that's more important than the receptionist your damn website and nobody tracks the conversion rate to that. When they call that office for the first time that better be your best likable, trusting employee you've got and then when they come, what are you gonna do? Someone's gonna take her back for x-rays? Well, that dental assistant she better be rocking hot like the mani-pedi lady. She needs to be the best cosmetologist in town and who shows up last? The dentist. Least important. It's like if you’re an NFL team you want a quarterback. I want the website to crush it. I want inbound, receiving telemarketing to be the best live monkey on your team. Your dental assistant to be the next and by the time you walked in you could be a cyclops with one eye and your team would say, “Hey, he's only got one eye but damn can he see with that eye”.
Dr. Sully: It’s fantastic. I’m gonna make you proud. I'm going back. I'm gonna make the video. I'm gonna get our team and make a video on our front page. That's basically like five reasons you should come to us or three you should come to us in 60 seconds. I'm doing that. I like that.
Howard: Yeah, man. Get likeable and trust in video because if I just saw two still pictures of you I wouldn’t feel anything.
Dr. Sully: It’s like a douche bag want a douche bag too.
Howard: When I see you I feel something. Why do people like scary movies? Because they want to feel something. Why do people like roller coasters? They want to feel something. That's what life is. Life is I want to feel something. I looked at your photo, am I feeling anything? Wouldn't I feel more if it was a video? This stuff is so obvious but humans move slow. I mean, for forty years, they had silent movies and record players. It's at forty years before one monkey thought, should we add those two together? That was an explosion. The third monkey came and said, “Hey, all ate popcorn. Now they can eat, see, smell, hear and the movie industry has never farted since. Make them land on your website and feel something. Scare them. Make them laugh. Make them feel something and you'll convert them to come in. Whoever picks up that call is ten times more important than you so you treat her with respect, you be humble, you respect her, you be nice. Who would want to piss off the lady on incoming calls? You go to any call center and they got people like every time you make a call they’ll give you a scratch lotto ticket. They're feeding you, they got measurements, they have contests of who's converted the most calls. When’s the last time you went to your front desk and say, “I'll tell you what. We measure calls. We get twenty inbound calls a day. Every damn incoming call that you schedule, I'm gonna walk across the street myself, my own fat ass, and buy you a lotto ticket. I hope you get ten people in today and win a million dollars”. Just the fact that you're even focusing on it, you'll crush it and I smell that you guys are both gonna crush it.
Dr. Sully: We hope so. We hope so. We appreciate it. Well, thank you so much for coming to podcast. We're excited.
Howard: All right. Have a great day guys.